IAS 2015: Tuberculosis and poor implementation of proven interventions threaten people with HIV and TB

VANCOUVER, Canada – Isoniazid preventive therapy is as effective in staving off tuberculosis as preemptively treating patients with HIV for tuberculosis, research results released here this morning showed. The findings came in one of a series of presentations this morning highlighting challenges posed by tuberculosis to the lives and well-being of people living with HIV, and failures to use proven interventions.

Mina Hosseinipour presented results from an AIDS Clinical Trial Group study that compared the impact of antiretroviral therapy and TB treatment to antiretroviral therapy and 6 months of isoniazid preventive therapy on severely immunosuppressed people with HIV. The study aimed to determine if automatically putting these individuals on TB treatment would more effectively reduce their chances of dying or developing tuberculosis compared to TB preventive therapy. The study found that both TB treatment and TB preventive therapy reduced the risks of acquiring tuberculosis or of dying, and both interventions had very similar results. The bottom line is that the study confirmed that TB preventive therapy is effective even in persons with HIV with severe immunosuppression and works as well as automatically treating these individuals for tuberculosis. The study authors conclude that automatic TB treatment in those without symptoms or confirmed TB results provides no added benefit.

The catch, as reported through two other presentations in the session is that TB preventive therapy has a critical but temporary impact on the risk of developing tuberculosis in countries with huge burdens of HIV and tuberculosis — a period of about one year according to a study presented at the session from South Africa. Most high burden countries in sub-Saharan Africa have made little or limited progress in providing TB preventive therapy to people with HIV, presentations showed. Annabel Baddeley from the World Health Organization presented data from 14 African counties indicating that only four had implemented TB preventive therapy as part of the standard of care for people with HIV and even those countries had done so in a very limited way. According to Baddeley, there are at least 866,000 people living with HIV in these 14 countries who have not been started on TB preventive therapy. There are 129,849 people co-infected with HIV and tuberculosis who have not yet been initiated on HIV treatment, despite numerous studies documenting the role of antiretroviral therapy of reducing the risk of tuberculosis among persons with HIV and the risk of dying from TB as well as very clear WHO guidelines.

Two other presentations in the session addressed the high burden of multidrug-resistant tuberculosis in people living with HIV in South Africa and Eastern Europe. Eric Budgell reviewed records from the health ministry in South Africa- the country with the highest burden of HIV in the world where tuberculosis is the leading cause of death. MDR-TB treatment success is low- 42 percent, and deaths from drug resistant TB are substantially higher among persons with HIV than among uninfected persons.

In chilling data presented by Anna Schultze from a review of clinics in Eastern Europe,southern Europe and Latin America of patients with HIV diagnosed with multi-drug resistant tuberculosis between 2011 and 2013, persons with HIV in Eastern Europe were far more likely to die than their counterparts in southern Europe and Latin America. The mortality rate for patients treated at the clinics in Eastern Europe was 23 percent. Patients in Latin America and southern Europe where 86 percent less likely to die from MDR-TB than those in Eastern Europe. The vast majority of people who died in the Eastern European clinics had either not received drug susceptibility testing or had been placed on drugs that were not active against their TB, despite the testing. The majority of patients in Eastern Europe had a history of injection drug use and had Hepatitis C.